在内镜下粘膜剖析后胃粘膜病变的患者中,病理升级和非治愈切除的风险因素
Pingjiang Wang1, Xu Zhao1, Ruicai Wang2
1Department of Gastrointestinal Surgery, Zibo Municipal Hospital, Zibo, 255400, Shandong, China.
BMC gastroenterology
|August 8, 2024
概括
与内镜下粘膜剖析 (ESD) 相比,内镜囊活检 (EFB) 经常误诊胃病变. 病变位置,大小和表面特征等关键因素可以预测胃癌的准确诊断和非治愈切除风险.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 病理学 病理学 病理学
背景情况:
- 内镜切片活检 (EFB) 的病理结果可能与术后内镜膜下切割 (ESD) 的发现不一致.
- 越来越多的ESD使用导致更多的非治疗性切除,突显了需要准确的手术前诊断和治疗规划的需要.
研究的目的:
- 为了确定手术后病理升级EFB后的风险因素.
- 在接受ESD的患者中确定非治愈切除的预测因子.
- 提高胃粘膜病变的临床和病理诊断准确度.
主要方法:
- 对来自262名患者的292个ESD标本 (2016年3月 - 2023年11月) 的回顾性分析.
- 对临床病理学信息的评估.
- 分析EFB和ESD之间的诊断一致性,以及非治疗性切除的风险因素.
主要成果:
- 从EFB到ESD的整体病理升级率为26.4%.
- 升级的预测因素包括胃附近的位置,病变大小>2厘米,和结节.
- 不分化的癌症和下膜透与非治愈的ESD切除有显著的关联 (在235名早期胃癌患者中20名).
结论:
- EFB可能不能完全代表胃内皮质瘤 (GIN);仔细内镜评估病变特征至关重要.
- 非治愈的内镜切除与未分化癌症和下膜透有关.
- 临床医生应该利用预测因素来选择适当的治疗方法,优化患者的治疗结果.
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